Method of studying renal morphology in hypertensive patients with and without renal artery stenosis

Although the size of the kidney is still the most commonly used as morpholo gical parameter, it is not enough sensitive for early detection of ischemic nephropathy. Purpose: To study a novel method of renal morphology analysis using spiral computed tomography angiography (CTA) in hypertensive patients with or with out unilateral atheromatous renal artery stenosis (RAS). Methods: Forty-nine hypertensive patients suspected RAS underwent spiral CT A. Arteriography showed significant RAS in 26 patients. Renal length, 3 upp er and 3 lower cortical thicknesses were measured in 46 control kidneys (C) i.e. 23 patients without RAS (group 1), in 26 stenosed (S) and in 26 oppos ite kidneys (OPP) i.e. 26 patients with unilateral RAS (group 2). Mean cort ical thickness (MCT), cortical area (CA), medullary length (ML) were calcul ated in the same groups. The reproducibility and agreement of measurements were investigated in two groups. The demographic parameters (age, sex, body mass index, and history of hypertension) were correlated with morphological parameters in group 1. Results: The reproducibility and agreement of measurements were confirmed ( R-2=0.53 to 0.93) except for anterosuperior thickness. The C kidneys were o f comparable morphology: MCT (mm)= 9.1 +/- 0.6; 9.2 +/- 1.0, CA (mm(2)) = 9 50 +/- 119; 934 +/- 157, ML (mm)= 85 +/- 11; 83 +/- 11. In group of Opp kid neys, MCT = 7.9 +/- 1.4 mm, CA = 806 +/- 210 mm(2), ML = 84 +/- 13 mm. In g roup of S kidneys, MCT=6.6 +/- 1.6 mm, CA=612 +/- 193 mm(2), ML=77 +/- 14 m m. Demographic parameters were not correlated to renal morphology. Conclusion: Spiral CTA is a suitable method to study renal morphology. Cort ical thickness and medullary length could be used to obtain a reliable diag nosis of early ischemic nephropathy.